


grey eyes, silver lining

by the_cloud_whisperer



Series: Cloud's Zukaang Fics [6]
Category: Avatar: The Last Airbender
Genre: Alternate Universe - Medical, Alternate Universe - Modern Setting, Fluff and Angst, Hurt/Comfort, Inspired by author's experiences, M/M, Mental Health Issues, Pathologist!Aang, Surgeon!Zuko, zukaangweek2020
Language: English
Status: Completed
Published: 2020-07-20
Updated: 2020-07-20
Packaged: 2021-03-05 03:35:40
Rating: Teen And Up Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 2,639
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/25387660
Author URL: https://archiveofourown.org/users/the_cloud_whisperer/pseuds/the_cloud_whisperer
Summary: Zukaang Week 2020 Day 1: DanceIt's eight p.m., and Zuko can finally stop by Aang's office next to the pathology lab. It's technically not necessary for him to visit in person. He knows Aang will already have dictated his note in the electronic medical record with the details of the tumor's histologic grade and its implications for the patient's diagnosis. But it's eight p.m., the sun's already set, and he could use a little sunshine in his life after working under cold fluorescent lights all day.
Relationships: Aang/Zuko (Avatar)
Series: Cloud's Zukaang Fics [6]
Series URL: https://archiveofourown.org/series/1219487
Comments: 27
Kudos: 87
Collections: Zukaang Week 2020





	grey eyes, silver lining

**Author's Note:**

> In my book, you only have to use the prompt word once, and not literally. So in this fic, it comes at the very end, and you get a well-plotted fic about stuff I actually am familiar with rather than my kinesthetically-challenged attempt at describing Zuko and Aang physically dancing. 
> 
> This was originally titled "Zukaang Hospital AU", and it has a couple of prequels that I've informally posted on Tumblr previously: [another Zukaang AU](https://the-cloud-whisperer.tumblr.com/post/187515459637/another-zukaang-au), [prequel](https://the-cloud-whisperer.tumblr.com/post/611830547523796992/the-cloud-whisperer-god-of-dust-this-reminded).
> 
> Some medical jargon to help with comprehension:  
> Levels of physicians: applies to the US only; don't know how other countries do it  
> \- Med student (4 years; typically after first 4 years of undergraduate education)  
> \- Resident: after you graduate med school, you are now a resident, and you can officially do things with varying levels of supervision. Intern: first year of residency. Residency length varies, with family medicine being 3 years and surgery being 5.  
> \- Chief resident: a resident physician in the final year of residency who is appointed to the position with additional duties like supervising didactics, organizing call schedules / resident rotation schedules, teaching medical students  
> \- Fellow: residents seeking further specialization may apply for fellowships, which are generally one to three years depending on degree of complexity.  
> \- Attending: a fully fledged doctor, responsible for supervising all levels below you. 
> 
> Surgical oncologist: surgeon who cuts out tumors  
> Whipple procedure: one of the most involved and complex procedures in surgical oncology, designed to remove pancreatic tumors as well as part of the small intestine and rejoin the two ends of the intestine back together  
> SMA: superior mesenteric artery, a major blood vessel often located close to the tumor in pancreatic cancers and hence carries a risk of being unintentionally cut during Whipple procedure  
> Gross room: where the tumors from surgery go to get chopped up into tiny slices for a pathologist to look at under the microscope  
> IRB: Institutional review board, a committee that most academic medical centers have that reviews proposed research study protocols to make sure they are ethical

Aang's chatting amiably with the circulating nurse in the operating room, waiting for the surgeons to finish removing the specimen from a Whipple procedure for pancreatic cancer. It's five in the afternoon, and by the time they're done, he should have a nice pancreatic head, duodenum, gall bladder, and several lymph nodes for frozen section to analyze for staging of the cancer.

Normally the lab couriers go down to the OR and deliver specimens to the gross room so that the pathologists don’t have to lift a finger, but Aang's head isn't so far up his ass that he can't be bothered to do the legwork himself. The more senior attendings might consider this beneath their dignity, but he doesn’t mind it. Besides, Zuko is the attending on this case, and he'd never pass up a chance to visit with his favorite surgical oncologist.

It's a grueling six-hour procedure, though, and Zuko doesn’t look like he's in the mood for small talk. The atmosphere around the operating table is tense and thick, almost too thick to be cut with a knife, and you know those surgical scalpels are _very_ sharp. Aang congratulates himself on the clever joke, _gotta remember that one to tell Zuko later._

Assisting Zuko on the case are a medical student who's less than thrilled about being here, judging by the weary slant of her shoulders and the constant shift of her weight from foot to foot, and Jason, one of the chief surgical residents. _And here is the source of the tension,_ he thinks. In the few minutes since Aang stepped in, Jason’s already snapped tersely at the med student for obstructing his visual field with a suction tube, twice at the scrub tech for handing him instruments too slowly, and passive-aggressively needled Zuko a couple of times for his chosen method of approach to resecting the tumor.

 _Yikes._ This is why Aang prefers pathology. In a room where stakes are this steep and a single poorly premeditated move could spell disastrous outcomes, there's bound to be high levels of stress and anxiety. He sighs, watching Zuko's bowed head as he focuses on the operating field. Aang has no hair on his head to worry about premature greying, but Zuko's hair, hidden under the blue sterile bonnet, certainly faces a grimmer fate.

His grievances for Zuko's hair are cut short by the sound of a strained voice. "No, no, nonono—oh, god damn it, Sarah, I _told_ you to be conservative with the stapler! Look, you've just transected the SMA, you idiot, couldn’t you have been more careful??"

Jason wastes no time in railing against the poor med student who accidentally cut something she wasn't supposed to cut, and everyone in the room freezes. Only Zuko moves, snatching up a hemostat and clipping off the cut vessel. "Suction and 3-0 sutures, please." He calmly busies himself with minimizing the damage, his motions efficient and quick. Poor Sarah looks like she's about to drop the surgical stapler, and the scrub takes pity on her, reaching to take it off her numb hands.

"Jason, if you wouldn’t mind taking the specimen and stitching anatomic landmarks. And please don’t yell at my med student, you were in her shoes just a few years ago."

"I know, but they should know better, you know how long this is going to take to fix—"

"That wasn't just a suggestion," Zuko says with finality.

Damn. Zuko hasn’t so much as raised his voice, but Aang feels chills going down his spine, and he would hate to be in the chief resident's place right now. Jason crossed a line.

They bring over the procured specimens in multiple sealed cups, and Aang carefully inspects the labelling. When everything is ready, he clutches his plastic biohazard bag and notices Sarah standing miserably in the corner, staring at the floor, too shaken to continue with the case.

"Zuko."

He shouldn’t be able to hear a soft murmur over the hum of all the machinery, but somehow, he looks up in response to his name. Aang points at his sample, the student, and the door, silently asking if he can take her out of this hostile environment and ensure that at least one person's bad day ends now. Zuko nods heavily, and Aang takes his signal.

"Come on. Sarah, right? Scrub out now, let's go to the path lab and I'll show you how we gross specimens for frozen section, yeah?"

The relief in her eyes is so heartbreakingly palpable, and Aang wonders how anyone puts up with this torment for eight weeks as a student, much less the rest of their life.

* * *

Eight p.m., and Zuko's finally done with the case and all the associated minutiae: talking to the family, talking to the ICU where the patient will go for recovery, dictating the procedural note, and not least, having a serious talk with Jason about his attitude. He doubts that he's really gotten through to his chief resident, though. You can't teach someone what they refuse to learn.

Eight p.m., and Zuko can finally stop by Aang's office next to the pathology lab. It's technically not necessary for him to visit in person. He knows Aang will already have dictated his note in the electronic medical record with the details of the tumor's histologic grade and its implications for the patient's diagnosis. But it's eight p.m., the sun's already set, and he could use a little sunshine in his life after working under cold fluorescent lights all day. Down the dim corridor, and only one office door is still open this late.

"I know you don’t like the cafeteria food."

He struggles to make logical sense of this greeting, but somehow, his foggy brain can't connect it with the appetizing paper plate of food sitting on Aang's desk, pushed to the side closer to Zuko, obviously intended for him.

"The staff lounge is closed by now, and I knew you'd get out of the case late. Sarah said the salmon crepe was good, so I ordered one to save for your dinner."

He sits down across from Aang, staring numbly at the plate as if he's forgotten the function of food.

"Usually food works better when you put it in your mouth and don’t just look at it," Aang fills in for him, the concern in his eyes not quite lining up with his whimsical banter.

Zuko picks up a plastic fork and digs in, eager to give the impression that everything is alright. He chews slowly, trying to melt the awkward silence punctuated by his leaden mastication. All he can think of to say is, "You took my med student to dinner?"

"Pfft, don’t look so scandalized. It was after we finished with the specimen, and I showed her some slides from old cases, and _then_ it seemed rude to send her home hungry after I'd kept her so long," Aang explains. "I mean, who else would treat her to the faculty lounge? _Jason?"_

“Thanks for getting her out of there. I felt so bad that I couldn’t do more in the moment, but I’ll talk to her when I get the chance.”

“You handled that pretty well. I’ve seen other attendings lose their shit over the smallest things.”

“I make it a point never to be short with a student unless they’re about to make a mistake that will cause harm to a patient or a team member.” Zuko sighs, thinking about all the mentors he’s had who have done otherwise. “Even then, there’s no point in raising your voice—that just puts everyone on edge, when the real priority is patient safety, not berating the med student.”

Aang nods; he seems to know not to press the subject anymore. "Keep eating; I'll pull up the digitized slides for us to look at."

He listens as Aang talks him through his impression of the patient's tumor grade, taking in perhaps every fourth word. This is their working relationship, after all. Depressed, burned out surgeon indulging angelic pathologist's compulsive need to care for him—now that’s a dynamic you don’t see in _House, MD_ or _Grey’s Anatomy._

"Rest and digest?" Aang notices he's made his best effort at the crepe, clocking in at a whopping two-thirds consumed. Sometimes he feels so exhausted that he doesn’t even sense hunger anymore. "There's a dessert crepe too. It's a bit deconstructed by now, but it’d be nice to take home for later."

"Mm." Zuko's thinking more clearly now that he's got some food in him, and he thinks that he would like to hear more of Aang's lovely voice, after an entire day of hearing only strident voices raised in anger, or patients’ and families' voices laced with fear and worries. He needs something different. "Show me the other slides you showed Sarah. Pretend I'm an impressionable young med student whom you're trying to sell on pathology. Corrupt me to the dark side if you will."

"Oh, I think after today, we've seen who the dark side really is, don’t you?" Aang says flippantly.

* * *

As he flicks through old slides of peripheral blood smears from his general pathology residency, Aang gets the sense that Zuko is really, decidedly not okay. Like, more not-okay than usual. Sure, he perks up a bit when he manages to identify a brilliantly magenta, violently granulated eosinophil, but otherwise…

"You stayed late last night, didn’t you?" Aang gives voice to his suspicions. "Like, late enough to call early morning and not late night, yeah?"

"Aang…" At a stern look, he quails and gives in. "Well, yes. At first, I stayed late working on an IRB proposal. The department chair was emphatic that he wants it tomorrow even though the research itself isn't to be done until next year. Then I was on call cross-covering four general surgery wards from home, but there was some kind of mix-up with the scheduling, and a second-year resident was holding the overnight pager by herself for all four services."

"Is that allowed?"

“No," he concedes, "but of course, she was too scared to speak up about it because it's Jason who sets the call schedule as the chief, and he's not about to admit that he screwed up. And it was especially busy yesterday, nurses paging all night for stroke-like presentations and patients randomly tanking their hemoglobin levels and what have you… I couldn’t leave Jin to deal with all that by herself, so I came back in from home and took half her calls while trying to finish my proposal. And that was… that."

He trails off sheepishly, feeling foolish for always complaining about work stressors whenever he's with Aang. Last night and today's incidents are not exactly commonplace, but they've happened before. He should be able to deal with this.

"So how long have you been awake?" Aang asks pointedly. "I assume you took call last night after a full day in the OR, didn’t sleep, and had cases all day today as well."

"Um… I had a couple of cat naps and I slept eight hours the night before, so…"

"Don’t waffle about it." Aang's words are cold with distilled anger at this point, and Zuko has never seen his grey eyes so stormy. " _How many hours?_ "

"…forty. Ish," he says in a small voice that definitely doesn’t sound like it belongs to surg onc's most promising junior attending.

Aang gets up, his motions deliberate and careful, not letting his chair scrape loudly or kicking at his work bag that rests on the floor. Only his knuckles, clenched white around his car keys, bely his outrage.

" You can’t drive in this state, so I’m taking you home," he says in response to Zuko's puzzled look. "You live in Palo Alto, right? That's got to be too far for the relief cab service."

"It is." Trust Aang to remember minute details about him that he only mentioned once in passing when they first met. He lurches to his feet. "It's fine; I'll take Caltrain home. I don’t have cases tomorrow, just clinic, so I don’t need to be up early anyways—"

Aang turns, and for a moment, Zuko sees every strand of tortured empathy condensing in those lucid, lovely eyes like a cloudy day. He imagines the usual, quasi-accusatory rejoinders that well-meaning people who aren’t surgeons tend to fall back on in an attempt at consolation: _danger to yourself and your patients you need to talk to someone aren't you worried about medical error and malpractice suits you need to stand up for yourself you need to talk to someone you're burned out and washed up and thirty-five and barely alive—_

You need to talk to someone.

 _But when I tried, no one responded,_ he thinks desperately. _Jason. Every one of the senior faculty in surg onc, plus more on the other surgical services. Everyone's just fighting to maintain their sanity amid the status quo because trying to change our circumstances only heralds insanity faster._

_Everyone says you need to talk to someone._

But Aang's the only one who actually listens and cares.

* * *

Predictably, Zuko falls asleep in his car five minutes after the keys go in the ignition, and Google Maps navigates them the rest of the way home. Aang hates to wake him up, but he needs to sleep in an actual bed.

"Zuko."

"Mmm." His head rolls on his neck, nose adorably smushed against the seatbelt. _When was the last time you saw anything so beautiful that wasn't a perfectly longitudinally cut blood vessel or the apple-green birefringence of Congo red-stained amyloid under polarized light?_

"Zuko, we're here."

He blinks sleepily into wakefulness, the headlights faintly illuminating his profile and casting highlights that Aang longs to kiss away from his cheekbones.

"I called Katara and told her you won't be coming to clinic in the morning." Katara is the third-year surg onc fellow and their mutual acquaintance. She's almost at the end of her fellowship training, and her expertise should be sufficient to see Zuko's patients alone. "She said she'd sign out the morning patients to you when you get there after lunch unless there's anything urgent, so you can sleep in." He hesitates. "I hope that wasn’t too forward of me…?"

Zuko undoes his seatbelt, shaking his head. "Nah, I probably would have told her the same."

He yawns, slightly refreshed from his nap, and Aang watches, transfixed, as he shivers through a mighty stretch, unintentionally knocking into the ornamental string of wooden beads hanging from the rearview mirror. In the dim light, their oscillatory swinging dapples his face with transient shadows, not dark enough to obscure the tiny, inviting smile he sets upon Aang.

"You're so sweet—I thought pathologists were all socially awkward and absorbed in their research and hate talking to people. Where's your halo, then?"

Lack of sleep clearly brings out Zuko's silver tongue. "You're one to talk," he counters, casually (play it cool, Aang, _play it cool_ ) curling his hand over the back of Zuko's where it rests next to the gearshift.

A serene silence stretches around them, and Aang thinks they may continue performing this awkward dance for the rest of their lives if he doesn’t do something. But… the moment doesn’t feel quite right, tiredness still pervading every inch of Zuko's soul and body.

"Thank you, Aang." He feels the hand within his turn and squeeze, and then it is gone as Zuko opens the door and gets out.

As he walks up the steps into his darkened townhouse, Aang absently kisses the palm of his own hand where it lay against Zuko's, a gentle promise between their interlaced fingers. A promise to keep letting Aang take care of him, to yield his stern outer façade for sweet, honest vulnerability.

**Author's Note:**

> A little depressing, but a little hopeful. Are all hospitals' surgery departments this toxic? No, but surgery does have a bad rap for being especially prone to physician burnout, and it really sucks. And the way our healthcare system and hospitals are designed, it's not going to change, ever. My personal interest is pathology, not surgery, partly because my dissection and hand-eye skills are terrible.
> 
> In this universe, Aang and Zuko work at UCSF (University of California at San Francisco). There just wasn't a good place to mention it in the text. I don't go to school there, but I spent a lot of time in and around Palo Alto about 30 miles south while shadowing and volunteering at Stanford, so why not give my childhood neighborhood a shout out? Everyone constantly asks me if I want to go back to California for residency, but I don't have strong feelings about it.
> 
> A lot of this was inspired by experiences from my awful surgery clerkship last year. I certainly don't have the worst horror stories, but I felt that a lot of me and my classmates' suffering was just unnecessary. Like - one attending yelled at me for not remembering the name of a blood vessel he was pointing to - like, sorry I didn't mean to intentionally disrespect you by not studying hard enough before coming to your surgery. What is the point of yelling, though?? It's not going to do any good, will make me feel bad, will get everyone else's nerves on edge, and leads to awkward silences. Another time the chief resident asked me so many questions I could not answer, and then I fumbled a suture because again, hand-eye skills bad, and twice I broke sterility (basically there are very strict rules about what you can and cannot touch on the operating field or it becomes nonsterile and I accidentally disregarded them) and the scrub tech flipped out at me. And I got so distressed eventually that I couldn't even answer the questions anymore and stood there struggling to swallow my sobs, and the chief finally felt bad and let me go take a break.
> 
> Fortunately at that time, the intern walked in with some questions, and he saw me there and thought that the chief made me go stand in the corner as punishment xD so afterwards he took me away to go see surgical consults in the ER, and he was super concerned xD it was very nice of him. 
> 
> It's honestly just... really bad. People go into surgery because they want to save lives and all that good stuff, and they do save a lot of lives, but often at the cost of their own. The terrible hours, the constant pressure to do more cases and do more research and pressure from the administration to achieve all these impossible standards... loss of any personal or family time whatsoever, particularly during residency when a lot of people are still young and just starting a family... shall I keep going? And so it's not surprising that they take it out on med students. As a third year, you'll be made to feel stupid for not knowing how to do something as simple as cut a piece of string with scissors - something you learned to do as a toddler, right? But it turns out that when using surgical scissors to cut sutures, you have to hold them in such an unintuitive way, plus your hands are shaking, and the attending is glaring at you for doing a sloppy job, and you just feel really.fucking.stupid.
> 
> Alright, I'm done. If you're considering applying to medical school (in the US), talk to me, I can give you some pointers, but ultimately, you're the only one who can be sure for yourself :)
> 
> Find me on other social media via [my Tumblr](http://the-cloud-whisperer.tumblr.com)!


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